Arthritis Foundation Unites With Patient and Employer Groups for PBM Reform

Nov. 13, 2025

As policymakers continue to work toward a funding agreement, the Arthritis Foundation, alongside a broad coalition of patient and employer organizations, urges Congress to prioritize comprehensive Pharmacy Benefit Manager (PBM) reform before the end of the year. 

PBM reform represents a meaningful, bipartisan opportunity for lawmakers to advance patient-focused solutions that improve access to affordable medications. Today, three PBMs process nearly 80% of prescription drug claims in the United States. This level of consolidation has reduced competition, increased drug costs and limited patient choice.  

In a letter to Congress, the Arthritis Foundation and partner organizations urged lawmakers to move forward with the PBM provisions included in the bipartisan December 2024 health care package, which were close to becoming law last year. These measures would strengthen transparency, accountability and fairness across the prescription drug system. 

Specifically, the letter calls for: 

• Full transparency of PBM business arrangements, financial incentives and formulary design; 
• A ban on spread pricing, which allows PBMs to profit from the difference between what insurers pay and what pharmacies receive; 
• 100% pass-through of rebates, discounts and fees to plan sponsors and patients; and 
• De-linking PBM compensation from drug list prices. 

These reforms represent an important step toward restoring trust in our health care system. As the letter states, “Every day without action is another day patients are forced to make difficult choices between their health and their financial stability.” 

As Congress continues its work to fully reopen the government and advance bipartisan health care solutions, the Foundation urges lawmakers to take this opportunity to move PBM reform forward for the benefit of all patients.